News to Use for Agents in the Senior Market

A Publication of Senior Marketing Specialists
Week of May 15, 2017

Cobra and Medicare

Whether or not you or a family member is covered by Medicare may affect your rights to group health plan coverage, in particular COBRA continuation coverage or the right to take advantage of certain enrollment rights you may have for COBRA continuation coverage.
If you are covered by both Medicare and a group health plan (and the plan’s rules allow such coverage) and a qualifying event occurs, then you may have the right to elect COBRA continuation coverage with respect to your group health coverage for the maximum period of coverage available. Becoming covered by Medicare at any time after election of COBRA continuation coverage will generally cause your COBRA continuation coverage to end. However, if you are the covered employee, and your COBRA continuation coverage ends because you become covered by Medicare, then the COBRA continuation coverage of your family members may be extended.Note: When the qualifying event is the end of employment or reduction of the employee’s hours, and the employee became entitled to Medicare less than 18 months before the qualifying event, COBRA coverage for the employee’s spouse and dependents can last until 36 months after the date the employee becomes entitled to Medicare.
Sources:“AN EMPLOYEE’S GUIDE TO HEALTH BENEFITS UNDER COBRA” – EMPLOYEE BENEFITS SECURITY ADMINISTRATION UNITED STATES DEPARTMENT OF LABORhttps://www.dol.gov/sites/default/files/ebsa/laws-and-regulations/laws/cobra/COBRAemployee.pdfCOBRA: 7 important facts:https://www.medicare.gov/supplement-other-insurance/how-medicare-works-with-other-insurance/who-pays-first/cobra-7-facts.html
DOL: http://webapps.dol.gov/elaws/ebsa/health/68.asp

Why is this important? Individuals often work past the age of 65 and will have to decide how to handle their group insurance options.

Drugs Covered By Medicare Part B

Drugs used with an item of durable medical equipment (DME): Medicare covers drugs infused through an item of DME, like an infusion pump or drugs given by a nebulizer.

Some antigens: Medicare will help pay for antigens if they’re prepared by a doctor and given by a properly instructed person (who could be you, the patient) under appropriate supervision.

Erythropoiesis–stimulating agents: Medicare will help pay for erythropoietin by injection if you have End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant) or need this drug to treat anemia related to certain other conditions.

Blood clotting factors: If you have hemophilia, Medicare will help pay for clotting factors you give yourself by injection.

Injectable and infused drugs: Medicare covers most injectable and infused drugs given by a licensed medical provider.

Note: Medicare Prescription Drug Plans may cover immunosuppressive drugs, even if Medicare didn’t pay for the transplant. Part D also may cover other immunosuppressive drugs that aren’t covered by Part B.

Oral cancer drugs: Medicare will help pay for some cancer drugs you take by mouth if the same drug is available in injectable form or is a prodrug of the injectable drug. As new oral cancer drugs become available, Part B may cover them.

Oral anti-nausea drugs: Medicare will help pay for oral anti-nausea drugs used as part of an anti-cancer chemotherapeutic regimen. The drugs must be administered immediately before, at, or within 48 hours after chemotherapy, and must be used as a full therapeutic replacement for an intravenous antinausea drug.
Source: https://www.medicare.gov/Pubs/pdf/10116-Your-Medicare-Benefits.pdf

Why is this important? When running drug comparisons you may run across very expensive medications showing as not covered by Part D plans. Often these are drugs covered under Medicare Part B.

Why is this important? When running drug comparisons you may run across very expensive medications showing as not covered by Part D plans. Often these are drugs covered under Medicare Part B.

Medicare for State/Local Government Employees and Retirees

State and local government employees hired before April 1, 1986 were exempt from paying the Federal Insurance Contributions Tax (FICA), and therefore not subject to mandatory Medicare coverage. Find out how counseling these new-to-Medicare beneficiaries differs from counseling those who come from the private sector in this helpful document: https://www.ncoa.org/resources/medicare-for-state-employees-and-retirees/

Why is this important? You may come across people who currently work for or have retired from a state or local government job and you will need to offer educated advice.